Props to Markos and the New York Times’ Carl Hulsey for noting something in the just-enacted Democratic House rules package that I missed: the retention of Newt Gingrich’s one good idea–term limits on committee chairmen.Neither of them get into the grittiest problem with this idea: the understandable reluctance of African-American chairs to give up their newfound power in the same seniority system that was used for so very long to obstruct and delay civil rights, and to marginalize and even humiliate minority Members.And by explaining the term limits issue strictly in terms of Caucus and leadership discipline, Markos and Hulsey also miss another well-identified problem with Perpetual Chairmanships: the tendency of Perpetual Chairmen to get trapped in the Iron Triangle uniting the executive-branch programs they supposedly oversee, the special-interest and advocacy groups that exist to defend and/or expand those programs (most of whom are avid campaign contributors), and their own professional committee staffs, who are typically cycling through the other sides of the triangle.According to Hulsey, Speaker Pelosi has privately indicated that the term-limits decision could be reversed later on. Let’s hope that’s not the case. There are other ways to ensure that minority voices in the House Caucus are heard; for one thing, “term-limited” committee and subcommittee chairs can be moved to equally influential perches. In any event, it will certainly be hard for this Democratic Congress to pose as a vehicle for “reform” if it backtracks on one of the most ancient and well-abused privileges of the Old Order.
TDS Strategy Memos
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By Ed Kilgore
March 24: The Republican Case Against Medicaid Expansion Continues to Crumble
There’s another turn in a story we’ve all been following for over a decade, so I wrote it up at New York:
The Affordable Care Act was signed into law 13 years ago, and the Medicaid expansion that was central to the law still hasn’t been implemented in all 50 states. But we are seeing steady, if extremely slow, progress in the effort to give people who can’t afford private insurance but don’t qualify for traditional Medicaid access to crucial health services. The U.S. Supreme Court case that upheld the ACA also made Medicaid expansion optional for states. Twenty-four states accepted the expansion when it became fully available at the beginning of 2014, and that number has steadily expanded, with the most recent burst of forward momentum coming from ballot initiatives in red states like Missouri, Nebraska, Oklahoma, South Dakota, and Utah. Now a 40th state is in the process of climbing on board: North Carolina. As the Associated Press reports, legislation is finally headed toward the desk of Governor Roy Cooper:
“A Medicaid expansion deal in North Carolina received final legislative approval on Thursday, capping a decade of debate over whether the closely politically divided state should accept the federal government’s coverage for hundreds of thousands of low-income adults. …
“When Democratic Gov. Roy Cooper, a longtime expansion advocate, signs the bill, it should leave 10 states in the U.S. that haven’t adopted expansion. North Carolina has 2.9 million enrollees in traditional Medicaid coverage. Advocates have estimated that expansion could help 600,000 adults.”
So what changed? Basically, over time the fiscal arguments North Carolina Republicans used to oppose the expansion began sounding increasingly ridiculous, AP suggests:
“GOP legislators passed a law in 2013 specifically preventing a governor’s administration from seeking expansion without express approval by the General Assembly. But interest in expansion grew over the past year as lawmakers concluded that Congress was neither likely to repeal the law nor raise the low 10% state match that coverage requires.
“A financial sweetener contained in a COVID-19 recovery law means North Carolina also would get an estimated extra $1.75 billion in cash over two years if it expands Medicaid. Legislators hope to use much of that money on mental health services.”
In other words, the GOP Cassandras warning that the wily Democrats would cut funding for the expansion in Congress once states were hooked turned out to be absolutely wrong. Indeed, the very sweet deal offered in the original legislation got even sweeter thanks to the above-mentioned COVID legislation. States like North Carolina appeared to be leaving very good money on the table for no apparent reason other than partisanship, seasoned with some conservative hostility toward potential beneficiaries. In this case, GOP legislators finally reversed course without much excuse-making. The AP reports:
“A turning point came last May when Senate leader Phil Berger, a longtime expansion opponent, publicly explained his reversal, which was based largely on fiscal terms.
“In a news conference, Berger also described the situation faced by a single mother who didn’t make enough money to cover insurance for both her and her children, which he said meant that she would either end up in the emergency room or not get care. Expansion covers people who make too much money for conventional Medicaid but not enough to benefit from heavily subsidized private insurance.
“’We need coverage in North Carolina for the working poor,’ Berger said at the time.”
That, of course, has been true all along. Final legislative approval of the expansion was delayed for a while due to an unrelated dispute over health-facility regulations. And the expansion cannot proceed until a state budget is passed. But it’s finally looking good for Medicaid expansion in a place where Democrats and Republicans are bitterly at odds on a wide range of issues.
There remain ten states that have not yet expanded Medicaid; eight are Republican “trifecta” states (Alabama, Florida, Georgia, Mississippi, South Carolina, Tennessee, Texas, and Wyoming) and two others have Republican-controlled legislatures (Kansas and Wisconsin). Perhaps the peculiar mix of stupidity and malice that keeps state lawmakers from using the money made available to them by Washington to help their own people will abate elsewhere soon.